Dieting among preadolescent and young adolescent females

A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence

OBJECTIVE

This study examined a 2-year period following an eating disorder (ED) diagnosis in order to determine patterns of health care utilization.

METHOD

We conducted a retrospective cohort study of children (n = 1560) diagnosed with an ED between 2000 and 2017. The ED diagnosis was made at a tertiary level hospital for children and adolescents presenting for outpatient assessment by specialist adolescent medicine physicians and recorded in a program database over this period of time. We then created three sex- and age-matched comparison cohorts using provincial health administrative databases including: a general population cohort, a diabetes cohort (to compare nonmental health care utilization) and a mood disorder cohort (to compare mental health care utilization). Outcomes included hospitalizations, emergency department visits, as well as general practitioner, psychiatrist, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcomes) were calculated.

RESULTS

Compared to the general population cohort, the ED cohort had higher odds and rates of all types of health care utilization. Compared to the diabetes cohort, the ED cohort had higher odds of nonmental health-related admissions (OR 1.45, 95% CI 1.09-1.95) and higher rates of nonmental health-related emergency department visits (RR 1.59, 95% CI 1.18-2.13). Compared to the mood disorder cohort, the ED cohort had higher rates of pediatrician visits, which were mental health-related (RR 14.88, 95% CI 10.64-20.82), however most other types of mental health service utilization were lower.

DISCUSSION

These patterns indicate that the service needs of young people diagnosed with EDs are higher than those with diabetes with respect to nonmental health admissions and emergency department visits, while in terms of mental health service utilization, there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits. These findings must be interpreted in the context of under-detection and under-treatment of EDs.

PUBLIC SIGNIFICANCE STATEMENT

Our study found that the health service needs of young people with EDs are higher than those with diabetes with respect to admissions and emergency department visits, while there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits.

Disordered eating, body image concerns, and weight control behaviors in primary school aged children: A systematic review and meta-analysis of universal-selective prevention interventions

OBJECTIVE

Body image concerns and extreme weight control behaviors frequently develop in childhood indicating an important age group for the implementation of universal-selective prevention approaches. This systematic review aimed to evaluate the effect of universal-selective prevention interventions addressing disordered eating, body image concerns, and/or extreme weight control behaviors in children aged 6-12 years.

METHOD

Nine databases were searched up to April 2021. Studies were included if they delivered a universal-selective prevention intervention to children aged 6-12 years and reported outcomes relating to body image, disordered eating, or weight control behaviors. The review was conducted in line with the PRISMA Guidelines.

RESULTS

A total of 42 articles describing 39 studies included in the review, with most (n = 24; 57%) classified as neutral quality. Thirty studies implemented an eating disorder specific universal-selective program and nine implemented lifestyle interventions plus content to address disordered eating risk factors. Meta-analysis (n = 16 studies) revealed an improvement in body image-related outcomes across all studies (standardized mean difference [SMD] 0.26 [95%CI 0.01, 0.51]); with a high level of heterogeneity (Î2 = 89.9%; p < .01). Meta-analysis according to gender revealed a general improvement in body image-related outcomes for girls (SMD 0.40 [95%CI 0.07, 0.73]), but not boys (SMD 0.23 [95%CI -0.24, 0.70]).

DISCUSSION

By investigating child, parental and teaching interventions and including outcomes such as weight control and disordered eating behaviors, a trend toward a reduction in eating disorder risk factors was observed, particularly body image-related outomes in girls. Future directions include embedded disordered eating prevention materials within existing lifestyle interventions and inclusion of more diverse samples.

The Association between Disordered Eating Behavior and Body Image Biological Maturation and Levels of Adipocytokines in Preadolescent Girls: The Healthy Growth Study

During puberty, rapid, complex hormonal, physical and cognitive changes occur that affect body image and eating behavior. The aim of this cross-sectional study, a secondary analysis of data from the Greek Healthy Growth Study, was to explore associations of disordered eating behaviors and body image in 1206 10–12-year-old girls during pubertal maturation, with serum leptin and adiponectin levels, according to body mass index (BMI). Eating behavior and disordered eating were assessed with the Dutch Eating Behavior Questionnaire (DEBQ) and the Children Eating Attitudes Test Questionnaire (ChEAT), respectively. Associations of components of DEBQ and ChEAT with maturation according to Tanner Stage (TS) and levels of leptin and adiponectin were explored by univariate and multivariate regression analysis. Adiponectin levels in girls at TS 1 were positively associated with the “social pressure to eat” score of ChEAT. Leptin levels in girls at TS 4 were positively correlated with the “restraint eating” score of DEBQ, and the “dieting”, “body image” and “food awareness” scores of ChEAT. After adjustment for TS and BMI, only “body image” and leptin remained significant. Further research may shed light on how these hormonal changes affect eating behaviors at various pubertal stages, contributing to “TS-specific” preventive strategies for eating disorders in girls.

The Mediating Role of Depression in the Relationship Between Body Image Dissatisfaction and Cyberbullying Perpetration

Preliminary evidence suggests that psychopathological factors (e.g., depression) are associated with higher engagement in cyberbullying perpetration, and those with elevated body image dissatisfaction (BID) are more susceptible to depression. However, the possible impact of body image dissatisfaction (BID) on cyberbullying remains untested. The present study examined the direct and indirect relationships of BID with cyberbullying via depression among a sample of 507 university students (mean age, 21.37 years; range 18–44 years). t tests showed that males had a higher prevalence of cyberbullying than females. Structural equation modeling indicated that BID was directly and indirectly associated with cyberbullying via depression among the total sample and males. However, BID was only indirectly related to cyberbullying via depression among females. Depression fully explained the relationship between BID and cyberbullying among females, although there were additional mediating factors between BID and cyberbullying among males. The findings are in accordance with theoretical models suggesting that individuals’ personal characteristics including psychopathological factors are associated with cyberbullying. Furthermore, males attempt to cope with their body image–related psychopathology with more externalizing behaviors than females.

COMPARATIVE ANALYSIS OF ADHERENCE TO THE MEDITERRANEAN DIET AMONG GIRLS AND ADOLESCENTS WHO PERFORM RHYTHMIC GYMNASTICS

ABSTRACT Introduction: Eating habits are one of the underlying aspects in rhythmic gymnastics as a sport with an aesthetic component. Objective: To evaluate adherence to the Mediterranean diet (MD) in girls and adolescents who perform rhythmic gymnastics, and the relationship of this adherence with Body Mass Index (BMI) and waist circumference. Methods: A prospective, descriptive comparative cross-sectional study with the participation of 221 gymnasts aged between 7 and 17 years. Adherence to the Mediterranean diet was analyzed using the KIDMED test. The waist circumference, height and weight of each gymnast were measured and the BMI calculated. Results: 41.63%, 52.94% and 5.43% of the total sample exhibited high, medium and low adherence, respectively, to the Mediterranean diet. The Mann-Whitney U test indicated significant differences in the rate of adherence to the Mediterranean diet between the two age groups, U = 5007.0, p = .016, r = .162. The adolescent gymnasts had greater adherence than the younger gymnasts. The total sample showed a positive correlation of the rate of adherence with weight (Rho = .143, p = .034), BMI (Rho = .152, p = .024) and waist circumference (Rho = .180, p = .007). Conclusions: The eating habits of adolescent gymnasts with regard to the Mediterranean diet are healthier than those of the younger gymnasts. All participants had normal BMI values. The KIDMED values of the total sample were related to weight and BMI. The high percentages of younger gymnasts with mean adherence to the MD evidenced the need to approximate their eating habits with Mediterranean standards. Level of evidence II; Comparative diagnostic study.

Body dissatisfaction and disordered eating symptoms in Finnish preadolescents

To evaluate whether body dissatisfaction is associated with disordered eating symptoms in Finnish preadolescents, and to assess the moderator effects of gender and body mass index on this association. We included 10,526 9- to 12-year-old preadolescents at baseline from the Finnish Health in Teens cohort. We used the Children's Eating Attitudes Test for assessing disordered eating symptoms and a pictoral instrument for evaluating body dissatisfaction, comparing self-assessment of wanted and current body shape. Odds ratio (OR) for disordered eating symptoms were estimated using unconditional logistic regression. A high percentage of preadolescents reported body dissatisfaction: 30.0% wanted a smaller body and 9.3% wanted a larger body. Only 2.2% of the participants had disordered eating symptoms. Preadolescents who wanted a larger (OR = 2.83; 95% confidence intervals (CI): 1.68-4.78) or smaller body (OR = 4.48; 95% CI: 3.20-6.26) had a higher risk of having disordered eating symptoms, compared to preadolescents satisfied with their body. Among preadolescents who wanted a smaller body, the effect of body dissatisfaction was more pronounced among girls (OR = 5.00; 95% CI: 3.25-7.70) than boys, and among normal-weight (OR = 6.82; 95% CI: 4.53-10.25) and underweight (OR = 23.23; 95% CI: 5.31-101.61) than overweight preadolescents. Body dissatisfaction is associated with disordered eating symptoms especially among girls, and those who are underweight and normal-weight. Our study suggests that, in the prevention of eating disorders, special attention should be given to preadolescents with body dissatisfaction.

Dietary Intake among Grade 7 Students from Southwestern Ontario Attempting to Gain Weight

Purpose: To describe dietary intake associated with intentional weight gain among grade 7 students.

Methods: Data were collected using the Waterloo web-based Eating Behaviour Questionnaire (WEB-Q) and measured heights/weights were taken to assess Body Mass Index (BMI). Dietary intake and the Canadian Healthy Eating Index-2009 were compared among participants who ate more to gain weight.

Results: Among 1015 participants, approximately 9% of participants were actively attempting to gain weight with more males than females (P < 0.001) and more underweight and normal weight than overweight/obese (P < 0.001) participants. Unadjusted analyses revealed that weight gainers versus non-weight gainers consumed more grain products (P < 0.001), meat and alternatives (P = 0.005), and other foods (P < 0.001), in addition to more total energy (P < 0.001). Although greater amounts of carbohydrates, fat, and protein were consumed among the weight gainers, no differences in the percentage of each macronutrient were observed once corrected for total energy intake. The adjusted model revealed that weight gainers were more likely to consume grain products in line with current recommendations, yet they were further from the recommendations for total fat intake.

Conclusion: Health promotion strategies need to consider intentional weight gain among young adolescents to ensure that appropriate weight gaining strategies are being followed to avoid potential detrimental health effects.

Validation of the Disordered Eating Attitude Scale for adolescents

ABSTRACT Objective To perform the psychometric evaluation of the Disordered Eating Attitude Scale (DEAS) for adolescents. Methods Sample consisted of 1,119 Brazilian adolescents (12-18 years old; 59.6% female) studying at technical schools in São Paulo state-Brazil, who answered an online survey with the DEAS, the Eating Attitude Test (EAT-26), and the Restraint Scale (RS). The internal consistency of the DEAS was assessed using Cronbach’s alpha. The convergent validity of DEAS was evaluated by means of Pearson’s coefficient correlation with EAT-26 and RS. The test-retest reliability was evaluated using a sub-sample of 61 adolescents. Known-groups validity was determined by comparing female student mean scores with scores of 33 female adolescents with eating disorders. Results The reliability of the DEAS was 0.79. EAT-26 and RS scores were positively correlated with DEAS scores (EAT: 0.78 for females and 0.59 for males, p < 0.001; RS: 0.63 for females and 0.48 for males, p < 0.001). The DEAS total and subscale scores differentiated students and patients with eating disorders (p < 0.001). The intra-class correlation coefficient for test-retest reliability was 0.87. Conclusion Results indicate that the DEAS adolescent version showed good internal consistency, convergent validity, known-groups validity, and test-retest reliability, suggesting its potential in identifying disordered eating attitudes among adolescents. It could also be helpful in identifying adolescents at risk from eating disorders, assisting in prevention programs.

Eating behaviors, body image, perfectionism, and self-esteem in a sample of Portuguese girls

OBJECTIVE

Eating disorders are an increasingly prevalent health problem among adolescent girls. It is well known that biological, psychosocial, and family-related factors interact in the development of this group of disorders. However, the mechanisms underlying the interaction between these variables are still poorly understood, especially in Portuguese adolescents. The aim of this study was to investigate the relationship between eating behaviors, body dissatisfaction, self-esteem, and perfectionism in a sample of Portuguese girls.

METHOD

A community sample of 575 Portuguese girls attending secondary school, answered self-report questionnaires including data on weight, height, and the Portuguese versions of the Contour Figures Rating Scale, the Child and Adolescent Perfectionism Scale, the Children Eating Attitudes Test, and the Rosenberg Self-Esteem Scale. SPSS version 20.0 for Windows was used for statistical analyses.

RESULTS

High scores in the Children Eating Attitudes Test were associated with significantly higher levels of body dissatisfaction (r = 0.339), socially prescribed perfectionism (r = 0.175), self-oriented perfectionism (r = 0.211), and low self-esteem (r = -0.292) (all p < 0.001). Self-oriented perfectionism partially mediated the relation between body dissatisfaction and disordered eating behaviors.

CONCLUSION

In this sample, dysfunctional eating behaviors appeared to correlate strongly with body dissatisfaction, low self-esteem, and perfectionism in girls. These themes should be addressed among female adolescents in the community.

The urgent matter of online pro-eating disorder content and children: clinical practice

During the last decade, much concern has been expressed about online pro-eating disorder communities (e.g., pro-anorexia websites and blogs) which encourage their users to engage in disordered eating behavior. The aim of the current paper is to reemphasize the importance of pro-eating disorder communities in light of the recent changes in the media landscape. With the increase of social networking sites, pro-anorexia messages have transplanted to more volatile and constantly changing media, such as Snapchat, Twitter, Facebook, Instagram, Pinterest, and many others. Most parents, educators, and health professionals are unaware of the sheer scope and nature of such pro-anorexia messages in these new contexts. The current paper will provide a review of pro-eating disorder websites, overview the effects of such websites on young people's health, examine the emergence of these messages on social media platforms, and highlight a number of guidelines for clinicians and parents.

CONCLUSION

The dissemination of online pro-eating disorder content to different types of social networking sites is becoming an urgent issue.

WHAT IS KNOWN

• Existing research on pro-eating disorder websites examines the prevalence and the content of these websites, and the effects of pro-eating disorder content on both clinical (eating disordered individuals) and non-clinical samples (non-eating disordered individuals). • The scope and nature of such anorexia messages is unknown to most adults, and many people (including parents and medical professionals) are insufficiently aware of the ease with which young people access, navigate, and use a wide range of online platforms.

WHAT IS NEW

• Pro-anorexia messages are no longer limited to websites that can be easily monitored, but instead have been transplanted to more volatile and constantly changing media such as Snapchat, Twitter, Facebook, Pinterest, and Tumblr which makes pro-eating disorder content much more easily accessible. • This paper wants to emphasize the implications of the presence of pro-eating disorder content on websites and social media. A number of guidelines for parents and clinicians are provided.

Type 2 diabetes in youth

Since the 1990s, concerns about a global obesity epidemic have flourished. These concerns regarding obesity are expressed in popular culture and scientific literature and emphasize both weight and weight loss when defining health and well-being. As a result scholars are now calling attention to a "shadow epidemic" of weight stigma that is shown to have harmful physiological and psychological impacts in youth. In tandem with "globesity" concerns, there has been a similar concern expressed over the epidemic of type 2 diabetes, which some have termed "diabesity." Although there is less known about diabetes stigma, the topic has much overlap with obesity stigma. In this narrative review we discuss the related problems of obesity and type 2 diabetes stigma, with an emphasis on issues specific to youth, as relevant. Drawing from literature on weight bias, critical weight studies, and Health at Every Size (HAES), we highlight pedagogical approaches to address obesity stigma and their implications to redress the problem of type 2 diabetes-related stigma in health care.

Restrained and external-emotional eating patterns in young overweight children-results of the Ulm Birth Cohort Study

Childhood obesity is one of the greatest public health challenges in Western countries. Abnormal eating behavior is thought to be a developmental trajectory to obesity. The Eating Pattern Inventory for Children (EPI-C) has not been used for children as young as eight years, and possible associations with body weight have not yet been established. Five hundred and twenty-one children of the Ulm Birth Cohort Study (UBCS; age eight) filled out the EPI-C and BMI was assessed. Adequacy of the scales was tested with confirmatory factor analysis and a MANOVA and cluster analysis established associations between eating patterns and BMI. The factor structure of the EPI-C was confirmed (GFI = .968) and abnormal eating behavior was associated with overweight (χ²(8) = 79.29, p<.001). The EPI-C is a valid assessment tool in this young age group. Overweight children consciously restrain their eating.

The association of early childhood cognitive development and behavioural difficulties with pre-adolescent problematic eating attitudes

OBJECTIVES

Few studies have prospectively investigated associations of child cognitive ability and behavioural difficulties with later eating attitudes. We investigated associations of intelligence quotient (IQ), academic performance and behavioural difficulties at 6.5 years with eating attitudes five years later.

METHODS

We conducted an observational cohort study nested within the Promotion of Breastfeeding Intervention Trial, Belarus. Of 17,046 infants enrolled at birth, 13,751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years, most with information on IQ (n = 12,667), academic performance (n = 9,954) and behavioural difficulties (n = 11,098) at 6.5 years. The main outcome was a ChEAT score ≥ 85th percentile, indicative of problematic eating attitudes.

RESULTS

Boys with higher IQ at 6.5 years reported fewer problematic eating attitudes, as assessed by ChEAT scores ≥ 85th percentile, at 11.5 years (OR per SD increase in full-scale IQ = 0.87; 0.79, 0.94). No such association was observed in girls (1.01; 0.93, 1.10) (p for sex-interaction = 0.016). In both boys and girls, teacher-assessed academic performance in non-verbal subjects was inversely associated with high ChEAT scores five years later (OR per unit increase in mathematics ability = 0.88; 0.82, 0.94; and OR per unit increase in ability for other non-verbal subjects = 0.86; 0.79, 0.94). Behavioural difficulties were positively associated with high ChEAT scores five years later (OR per SD increase in teacher-assessed rating = 1.13; 1.07, 1.19).

CONCLUSION

Lower IQ, worse non-verbal academic performance and behavioural problems at early school age are positively associated with risk of problematic eating attitudes in early adolescence.

Eating problems in Irish children and adolescence - EPICA

OBJECTIVES

To examine eating concerns in a cohort of Irish adolescents.

METHODS

Students from a stratified random sample of post primary schools were screened using the EAT-26, the EDI-III and a study specific questionnaire.

RESULTS

A total of 3,031 students (mean age 14.74, range 12-19) enrolled in the study. The majority of respondents felt popular (91%), happy (75.2%) and perceived themselves to have a good quality of life (86.8%). Despite this, 32% of females dieted, 29.4% were dissatisfied with their bodies, and 10.8% scored above 20 on the EAT-26. Adolescents always on a diet reported a lower quality of life (QoL) X2(16, N=2,961) =144.43, p <.000, perceived themselves to be less popular X2(15, N=2,963) =53.26, p <.000 and less academically able X2(16, N=2,297) =43.96, p<.000, than those who never dieted. Comparing EPICA values to published norms, Irish males had significantly lower EAT scores, females had comparable total EAT-26 scores but significantly lower levels of dieting and higher levels of bulimic features and oral control. Girls in mixed schools had higher rates of body dissatisfaction F (1,2855) = 16.61, p <.001 and drive for thinness F (1,2860) = 11.78, p <.005 than girls attending same sex schools.

CONCLUSIONS

Weight and body image concerns were high among Irish adolescents, especially females, with higher than expected levels of bulimia and oral control scores on the EAT but lower scores on the dieting subscale. Females attending mixed sex schools appear most at risk of eating pathology.

Self-objectification, body image disturbance, and eating disorder symptoms in young Australian children

Self-objectification has been examined extensively in adult populations. Despite theoretical evidence suggesting that children may also be vulnerable to experiencing self-objectification, whether children do self-objectify has not been determined. Accordingly, the present study examined the degree to which children self-objectify. The prevalence of body image and eating disturbances in this population, and the relationship between self-objectification and these disturbances, were also investigated. Results from over 250 boys and girls aged 6-11 years revealed that young girls report levels of self-objectification that are similar to those observed among older girls and women. Self-objectification was also found to be meaningfully related to body image and eating disturbances in children. A significant proportion of children reported body dissatisfaction and a minority engaged in disordered eating behaviours in the four weeks prior to the assessment. These results suggest that children may be at risk of experiencing the negative psychological outcomes associated with self-objectification.

Disordered eating and health-related quality of life in overweight and obese children

OBJECTIVES

To examine disordered eating and associations with health-related quality of life (HRQOL) in rural overweight/obese (OW/OB) children.

METHODS

Cross-sectional analyses were conducted with 272 rural OW/OB children aged 8-12 years (M = 10.36; SD = 1.39). Child anthropometrics, demographics, disordered eating attitudes, unhealthy weight control behaviors (UWCBs), and HRQOL were measured. Relationships between these variables were analyzed using bootstrapped multiple linear regressions.

RESULTS

Clinically significant disordered eating attitudes were endorsed by 17% of the sample, and the majority endorsed UWCBs. Disordered eating attitudes and weight status were the most common predictors of HRQOL. Disordered eating attitudes and UWCBs were negatively related to emotional HRQOL but were unrelated to social, school, or physical HRQOL.

CONCLUSIONS

Disordered eating is a serious and relevant problem in OW/OB children living in rural areas and may be indicative of impairments in emotional functioning. Early intervention may reduce the risk for eating disorders and associated negative sequelae.

Effects of promoting longer-term and exclusive breastfeeding on childhood eating attitudes: a cluster-randomized trial

BACKGROUND

Observational studies suggest that breastfeeding benefits later maternal child-feeding practices, which in turn may contribute to positive eating attitudes. We investigated the effect of a randomized intervention to increase duration and exclusivity of breastfeeding on pre-adolescent eating attitudes.

METHODS

Long-term follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial in 31 maternity hospitals and affiliated polyclinics in Belarus. Sites were randomly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding (n = 16 sites), or a control intervention of continuing usual care (n = 15 sites); 17 046 healthy infants were enrolled in 1996-7, of whom 13 751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years of age. A ChEAT score ≥ 22.5 (85th percentile) was used as an indicator of problematic eating attitudes. Analysis was based on intention-to-treat, accounting for clustering within hospitals/clinics.

RESULTS

Compared with the control arm, the experimental intervention substantially increased breastfeeding exclusivity (43.3% vs 6.4% exclusively breastfed at 3 months of age) and duration of any breastfeeding throughout infancy. The proportion of children with ChEAT scores ≥ 22.5 was lower in the experimental than control arm (boys 11.4% vs 17.2%; girls 18.5% vs 23.4%) [cluster-adjusted odds ratio (OR), boys: 0.44; 95% confidence interval (CI): 0.21,0.93; girls: 0.51; 95% CI: 0.27,0.99). Results were robust to adjustment for potential confounders and using a ChEAT score ≥ 25.5 (91st percentile) as the outcome (OR: 0.53; 95% CI: 0.28,1.03).

CONCLUSIONS

An intervention to improve the duration and exclusivity of breastfeeding among term infants in Belarus was associated with a reduction in problematic eating attitudes at 11.5 years of age.

Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes

BACKGROUND

Few studies have prospectively investigated whether early-life exposures are associated with pre-adolescent eating attitudes.

OBJECTIVE

The objective of this study is to prospectively investigate associations of parental smoking, alcohol use, marital status, measures of maternal satisfaction, self-reported parental body mass index (BMI) and clinically measured childhood BMI, assessed between birth and 6.5 years, with problematic eating attitudes at 11.5 years.

METHODS

Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus. Our primary outcome was a Children's Eating Attitudes Test (ChEAT) score 22.5 (85th percentile), an indicator of problematic eating attitudes. We employed multivariable mixed logistic regression models, which allow inference at the individual level. We also performed instrumental variable (IV) analysis using parents' BMIs as instruments for the child's BMI, to assess whether associations could be explained by residual confounding or reverse causation.

SUBJECTS

Of the 17 046 infants enrolled between 1996 and 1997 across Belarus, 13 751 (80.7%) completed the ChEAT test at 11.5 years.

RESULTS

In fully adjusted models, overweight children at age 6.5 years had a 2.14-fold (95% confidence interval (CI): 1.82, 2.52) increased odds of having ChEAT scores 85th percentile at age 11.5 years, and those who were obese had a 3.89-fold (95% CI: 2.95, 5.14) increased odds compared with normal-weight children. Children of mothers or fathers who were themselves overweight or obese were more likely to score 85th percentile (P for trend 0.001). IV analysis was consistent with a child's BMI causally affecting future eating attitudes. There was little evidence that parental smoking, alcohol use, or marital status or maternal satisfaction were associated with eating attitudes.

CONCLUSION

In our large, prospective cohort in Belarus, both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later.

Do human females use indirect aggression as an intrasexual competition strategy?

Indirect aggression includes behaviours such as criticizing a competitor's appearance, spreading rumours about a person's sexual behaviour and social exclusion. Human females have a particular proclivity for using indirect aggression, which is typically directed at other females, especially attractive and sexually available females, in the context of intrasexual competition for mates. Indirect aggression is an effective intrasexual competition strategy. It is associated with a diminished willingness to compete on the part of victims and with greater dating and sexual behaviour among those who perpetrate the aggression.

Relationships between health behaviors and weight status in American Indian and white rural children

PURPOSE

Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States.

METHODS

Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States.

FINDINGS

Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys.

CONCLUSIONS

Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

O que é comportamento de risco para transtornos alimentares em adolescentes?

OBJETIVO: Caracterizar comportamento de risco para transtornos alimentares (TA) e sua frequência entre adolescentes em uma revisão da literatura nacional e internacional. MÉTODOS: Foi realizada uma busca bibliográfica por meio de uma revisão integrativa nas bases de dados PubMed (US National Library of Medicine)e Lilacs e no portal SciELO,utilizando-se os descritores relacionados à "eating disorder risk behavior". Foram selecionados artigos publicados nos últimos 10 anos, nos idiomas português, espanhol e inglês, e especificamente com adolescentes. Foram avaliados 76 artigos e analisados a nomenclatura e os instrumentos utilizados para avaliar comportamento de risco para TA e sua prevalência. RESULTADOS: Encontrou-se uma série de termos para avaliar risco para TA. A metodologia mais utilizada foi a de questionários e escalas, destacando-se o EAT-26 ou 40 e o BITE, dentre os mais frequentes; a prevalência de risco variou de 0,24% a 58,4%. CONCLUSÃO: Diferentes nomenclaturas e instrumentos são utilizados para avaliar comportamento de risco para TA entre adolescentes, com grande amplitude nos resultados de prevalência. Maior padronização de termos e metodologia de avaliação permitiriam melhor comparação entre estudos epidemiológicos em diferentes localidades.

Body dissatisfaction and disordered eating attitudes in 7- to 11-year-old girls: testing a sociocultural model

We examined the sociocultural model of body dissatisfaction and disordered eating attitude development in young girls for the first time. According to the model, internalizing an unrealistically thin ideal body increases the risk of disordered eating via body dissatisfaction, dietary restraint, and depression. Girls aged 7-11 years (N=127) completed measures of thin-ideal internalization, body dissatisfaction, dieting, depression, and disordered eating attitudes. Participants' height and weight were measured and their body mass index calculated. Thin-ideal internalization predicted disordered eating attitudes indirectly via body dissatisfaction, dietary restraint, and depression; it also predicted disordered eating attitudes directly. Path analyses showed that a revised sociocultural model fit well with the data. These data show that a sociocultural framework for understanding disordered eating and body dissatisfaction in adults is useful, with minor modifications, in understanding the development of related attitudes in young girls.

A risk model for preadolescent disordered eating

OBJECTIVE

This study tested this risk model for disordered eating in preadolescent girls: pubertal onset is associated with increases in negative urgency (the personality tendency to act rashly when distressed); negative urgency influences eating disorder symptoms by shaping psychosocial learning (expectancy formation), thus indirectly influencing symptom levels; and many influences on purging are mediated by binge eating.

METHOD

Nine hundred five fifth grade girls completed questionnaire measures of eating pathology, negative urgency, and dieting/thinness and eating expectancies.

RESULTS

Binge eating and purging behaviors were present in fifth grade girls. As anticipated, pubertal status was associated with higher levels of negative urgency, negative urgency was associated with each expectancy measure, quadratic dieting/thinness and eating expectancies were associated with binge eating, and binge eating was associated with purging.

DISCUSSION

It is important and feasible to develop risk models for preadolescent eating disordered behaviors. Our model that integrates puberty, personality, and psychosocial learning appears promising.

Disordered eating in women: implications for the obesity pandemic

Contemporary Western society emphasizes thinness for women, and the ideal female body size has become progressively smaller over the past half century. Meanwhile, the actual female body size has increased steadily, and rates of aberrant attitudes and behaviours surrounding food and weight have risen and tend to be much more common in overweight individuals. Thus disordered eating and excess body weight may perpetuate each other's development. We have synthesized the literature concerning female body size and disordered eating within a sociocultural context. Eight cognitions and behaviours that occur in women were examined: media exposure, weight stereotypes, body dissatisfaction, dieting, "fat talk," emotional eating, perfectionism, and the "superwoman" ideal. The research literature suggests that these factors may play a role in both disordered eating and obesity. Furthermore, these factors may induce triggers, exacerbated by perfectionism and excess weight, that increase the risk of binge eating. These triggers include interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. Comprehensive interventions targeting the indicated sociocultural cognitions and behaviours, combined with healthy living education, may be the most effective strategy for reducing the prevalence of disordered eating and obesity among females.

Children's eating attitudes test: validation in a sample of Spanish schoolchildren

OBJECTIVE

To validate the Spanish version of the Children's Eating Attitudes Test (ChEAT).

METHOD

The factor structure and other psychometric characteristics of the questionnaire were examined using the answers of 38,554 schoolchildren. Diagnostic efficiency was based on a standardized clinical interview of 968 schoolchildren who had previously completed the questionnaire.

RESULTS

Five factors ("preoccupation with thinness," "dieting," "social pressure to eat," "purging," and "preoccupation with food and oral control") explained 46% of the variance. Cronbach's α was .858 for the total scale. The area under the receiver operating characteristic curve was .851. Sensitivity (SE) was 27% and specificity (SP) 96% for a cut-off of 20. A more appropriate cut-off was 15, where SE and SP were 62% and 90% respectively, and the positive and negative predictive values 27 and 98%.

DISCUSSION

The ChEAT psychometric characteristics are adequate. The questionnaire is valid. A cut-off point of 15 is recommended for adolescents.

Tween sex differences in snacking preferences during television viewing

Television viewing is associated with an increased risk in childhood obesity. Research surrounding food habits of tweens largely bypasses snacking preferences while watching television in the home. The aim of this cross-sectional study was to describe snacking prevalence by tween sex and to describe parental rules surrounding snacking while watching television at home. Survey data were obtained in 2008 from 4th- through 6th-grade students (n=1,557) who attended 12 New England schools. Complete self-reported measures (n=1,448) included demographics, household and bedroom television ownership, television watching frequency, snacking prevalence, snacking preferences, and parental rules regarding snacking while watching television. Comparisons were generated using χ(2) analyses. Overall, the majority of children (69.2%) snacked "sometimes" or "always" during television viewing, with the majority of responses (62.9%) categorized as foods. The most popular food snacks for both sexes in this sample were salty snacks (47.9%), with fruits and vegetables ranking a distant second (18.4%). Girls (22.6%) selected fruits and vegetables more frequently than boys (14.7%) (P=0.003). Of those drinking beverages (n=514), boys selected sugar-sweetened beverages more often than girls (43.5% vs 31.7%; P=0.006), and girls chose juice more often than boys (12.3% vs 6.1%; P=0.02). Overall, approximately half (53.2%) of the students consumed less-healthy snacks while watching television. Interventions for parents and both sexes of tweens focusing on healthy snacking choices may have long-term beneficial outcomes.

'I want to lose weight': Early risk for disordered eating?

The present study examined the risk of disordered eating and its relation to attempts to lose weight by surveying a Maritime Canadian sample of 247 girls and boys in grades 6, 7 and 8. Current attempts to lose weight were highest in grade 8 girls (41% of girls and 9% of boys) compared with grade 6 (14% of girls and 24% of boys) and grade 7 (21% of girls and 13% of boys) children. Of those trying to lose weight, 71.4% were in the average range for weight and height, 12.2% were overweight and 16.3% were obese. The Children's version of the Eating Attitudes Test (ChEAT) was used to assess eating attitudes and behaviours, and the Rosenberg Self-Esteem Scale was used as a measure of self-esteem. The results showed that 8.5% of the children fell in the high-risk group for disordered eating (ChEAT score 20 or higher). Those in the high-risk group were significantly more likely to fear being overweight (90%), to have tried to lose weight in the past (81%), to be currently trying to lose weight (76%), and to have engaged in binge eating (38%) and self-induced vomiting (24%). The best predictor of membership in the high-risk group for girls was current attempts at weight loss and having lower self-esteem. Only two boys fell in the high-risk group. Body mass index and current weight category (underweight, average, overweight and obese) could not explain the differences between the low- and high-risk groups. Knowing that a child is trying to lose weight can aid in identifying youth at risk for disordered eating, and can provide an opportunity for preventive education.

Self-silencing and anger regulation as predictors of disordered eating among adolescent females

The main purpose of this study was to examine how self-silencing, emotional regulation, and body-esteem differentiated healthy eating from different patterns of disordered eating. A community sample of adolescent females was classified as either: 1) Restrained Eaters (n=104, M(age)=14.48); 2) Emotional Eaters (n=125, M(age)=14.52); or, 3) Healthy Eaters (n=396, M(age)=13.71). A discriminant function analysis revealed two significant functions. The first function differentiated the two disordered eating groups (i.e., the restrained and emotional eaters) from the healthy group, with the disordered eating groups scoring significantly higher on levels of self-silencing and anger regulation, and lower on body-esteem. The second function differentiated between the restrained and emotional eaters, with the emotional eaters reporting higher levels of externalized self-perception and anger, and lower levels of body-esteem. The results suggest that body-esteem and anger suppression were the most influential variables in differentiating between groups. The findings are discussed in terms of the implications for disordered eating prevention and treatment programs.

Body Ideals and Body Dissatisfaction Among a Community Sample of Ethnically Diverse Adolescents on Kauai, Hawaii

INTRODUCTION

Body dissatisfaction (BD), a risk factor for eating disorders, is occurring at younger ages and among a wide range of socioeconomic and cultural groups.

OBJECTIVE

To describe body ideals and prevalence of body satisfaction among an ethnically diverse population of male and female students in Hawaii.

METHODS

An anonymous cross-sectional survey including biographical information and the figure drawing screen was distributed to 7th through 12th grade students.

RESULTS

Of the 1330 completed surveys, 19% of students were significantly dissatisfied with their bodies. Males were at greater risk than females for total BD (25.8% vs. 13.3%; p<0.001) and for BD in the direction of wanting to be larger (11.3% vs. 2.3%; p<0.001). Males and females were at similar risk for BD in the direction of wanting to be thinner (14.6% vs. 11.6%; p=0.11). Prevalence of BD in the direction of wanting to be thinner was significantly different (p<0.05) among ethnic groups. There were no significant differences in BD based on grade level or SES.

CONCLUSIONS

BD exists among nearly 1 out of 5 adolescents, with differing patterns for males and females, and with certain ethnic groups being at higher risk.

IMPLICATIONS

Studies to understand risk and protective factors by sex and among different ethnic groups may help generate tailored prevention strategies. Further research is needed to better understand the mechanisms underlying the bidirectional BD seen in males and potential outcomes.

Peer effects and the freshman 15: evidence from a natural experiment

This study investigates the importance of peer effects in explaining weight gain among freshman college students. We exploit a natural experiment that takes place on most college campuses in the US--randomized roommate assignments. While previous studies suggest that having an obese spouse, friend, or sibling increases one's likelihood of becoming obese, these social interactions are clearly non-random. We collect data from female students living on campus at a private Midwestern university at the beginning and end of their first year of college. Our findings suggest that the amount of weight gained during the freshman year is strongly and negatively correlated to the roommate's initial weight. Further, our analysis of behaviors suggests that female students adopt some of their roommates' weight-loss behaviors which cause them to gain less weight than they otherwise would have. In particular, we find evidence that this effect may be through influences in eating, exercise, and use of weight loss supplements.

The relation between eating- and weight-related disturbances and depression in adolescence: a review

Depression often emerges during adolescence and persists into adulthood. Thus, it is critical to study risk factors that contribute to the development of depression in adolescence. One set of risk factors that has been recently studied in adolescent depression research is eating- and weight-related disturbances (EWRDs). EWRDs encompass negative cognitions related to one's body or physical appearance, negative attitudes toward eating, and unhealthy weight control behaviors. However, there have been no comprehensive reviews of EWRDs and depression research that are contextualized within developmental frameworks of adolescent depression. Thus, this review will summarize research findings on the relation between EWRDs and depression in adolescence using a cognitive vulnerability developmental framework. First, a brief overview of epidemiological findings on depression is provided in order to highlight the importance of examining depression in adolescence. Second, a cognitive vulnerability developmental framework that can be used to conceptualize depression in adolescence is described. Next, theories and findings on EWRDs and depression in adolescence are summarized within this framework. Research limitations and suggestions for future research are provided. Finally, implications of this review related to the assessment, intervention, and prevention of depression in adolescence are provided.

Responsiveness of the Eating Disorders Quality of Life Scale (EDQLS) in a longitudinal multi-site sample

BACKGROUND

In eating disorders (EDs), treatment outcome measurement has traditionally focused on symptom reduction rather than functioning or quality of life (QoL). The Eating Disorders Quality of Life Scale (EDQLS) was recently developed to allow for measurement of broader outcomes. We examined responsiveness of the EDQLS in a longitudinal multi-site study.

METHODS

The EDQLS and comparator generic QoL scales were collected in person at baseline, and 3 and 6 months from 130 participants (mean age 25.6 years; range 14-60) in 12 treatment programs in four Canadian provinces. Total score differences across the time points and responsiveness were examined using both anchor- and distribution-based methods.

RESULTS

98 (75%) and 85 (65%) responses were received at 3 and 6 months respectively. No statistically significant differences were found between the baseline sample and those lost to follow-up on any measured characteristic. Mean EDQLS total scores increased from 110 (SD = 24) to 124.5 (SD = 29) at 3 months and 129 (SD = 28) at 6 months, and the difference by time was tested using a general linear model (GLM) to account for repeated measurement (p < .001). Responsiveness was good overall (Cohen's d = .61 and .80), and confirmed using anchor methods across 5 levels of self-reported improvement in health status (p < .001). Effect sizes across time were moderate or large for for all age groups. Internal consistency (Chronbach's alpha=.96) held across measurement points and patterns of responsiveness held across subscales. EDQLS responsiveness exceeded that of the Quality of Life Inventory, the Short Form-12 (mental and physical subscales) and was similar to the 16-dimension quality of life scale.

CONCLUSIONS

The EDQLS is responsive to change in geographically diverse and clinically heterogeneous programs over a relatively short time period in adolescents and adults. It shows promise as an outcome measure for both research and clinical practice.

Eating behaviour and body satisfaction in mediterranean children: the role of the parents

Although the prevalence of fully expressed Eating Disorders is rare in young children, childhood eating disturbances are fairly common. Parents can play a facilitating role for the development of overweight and eating problems among their children. The aim of this study is to detect the possible relationships between children’s eating attitudes and behaviour and the parents’ beliefs about eating habits and body shape of their offspring.

This survey was conducted in the area of Arezzo (Italy), on 900 children, aged 7-12, and on their parents/substitute caregivers. The Kids’ Eating Disorder Survey questionnaire, and the CIBUS questionnaire were administered.

A fully expressed Eating Disorder was diagnosed in two kids only. KEDS total score and weight/dissatisfaction subscale score positively correlated with parents’ answers to the following CIBUS’ items (How do you consider the body shape of your son/daughter? How much does your son/daughter eats? Have you ever thought of putting your son/daughter on a diet?). Positive correlations between the children BMI, desired BMI and the aforementioned CIBUS’ items were found.

The prevalence of formal Eating Disorders in children aged 7-12 is low. Children appear to be more preoccupied with their weight than with their body shape. Parents’ beliefs about the offspring’s body shape and eating habits have a relevant impact on children’s eating attitudes and behaviour.

Obesity and eating disturbances are common in 15-year-old adolescents. A two-step interview study

A two-step interview study of eating disorders (EDs) and sub-clinical EDs in 15-year-old adolescents was carried out in western Finland. The sample consisted of all ninth graders in a well-defined catchment area (n=606, 98.2% of eligible students). In the first step, a self-report questionnaire was administered at schools regarding mental health problems and life circumstances. The questions concerning anorectic and bulimic eating pathology were formulated according to the DSM-IV diagnostic criteria of EDs. The second step consisted of a semi-structured interview Rating of Anorexia and Bulimia-Teenager version (RAB-T) to which 128 subjects were invited, on the basis of their answers to questions about eating pathology in the questionnaire. The participation rate in the interview was 88.3%. The lifetime prevalence rate for anorexia nervosa (AN) in 15-year-old girls was 1.8% and the point prevalence rate 0.7%. No cases of AN were found among the boys. All criteria fulfilling cases of bulimia nervosa (BN) were not found in our sample. High rates of AN not otherwise specified (AN-NOS; 4.9%) and sub-clinical EDs (4.9%) were found among the girls; 6.7% of girls and 0.6% of boys were regarded as being "at risk" of developing EDs. Data on height and weight are based on current measurements taken at school healthcare; 22% of boys were overweight or obese compared with 16% of girls.

Healthy eating index-C is positively associated with family dinner frequency among students in grades 6-8 from Southern Ontario, Canada

BACKGROUND/OBJECTIVES

Unhealthy eating behaviours may contribute to the rising prevalence of childhood obesity in Canada. The purpose of this study was to describe family dinner frequency (FDF) and its associations with overall diet quality.

SUBJECTS/METHODS

The sample included grades six (n=372), seven (n=429) and eight (n=487) students from Southern Ontario. Data were collected with the Food Behaviour Questionnaire, including a single 24-h dietary recall and questions about individual meals. Diet quality was calculated using the Healthy Eating Index-C (HEI-C), which is a recently modified diet quality index.

RESULTS

The majority of participants (65%) reported frequent family dinner meals (6-7 days/week versus 20% on 3-5 days/week and 15% on 0-2 days/week). Diet quality scores were higher among participants reporting 6-7 dinners/week (HEI-C=66.2 versus 62.1 and 62.8 for 0-2 and 3-5 days/week, respectively, P<0.001). Adjusted models reported that diet quality scores were also associated with whom participants consumed breakfast (P<0.001), lunch (P<0.001) and dinner (P<0.001), yet they were most strongly associated (negatively) with participants who skipped the meal altogether.

CONCLUSIONS

Increased family dinner meals were positively associated with daily diet quality and negatively associated with breakfast and lunch skipping. Promoting family dinner meals in healthy living intervention strategies is advised.

Associations between family dinner frequency and specific food behaviors among grade six, seven, and eight students from Ontario and Nova Scotia

PURPOSE

Family dinner frequency has recently been associated in the literature with improved dietary profiles and healthy body weight in children and adolescents. However, it is not known whether family dinners are associated with other commonly reported food behaviors (fast food and soft drink consumption, breakfast skipping, and dieting) and attitudes (body weight concerns and self-efficacy for healthy eating) among Canadian students in grades 6, 7, and 8.

METHODS

A total of 3223 participants from Northern Ontario (Porcupine Region), Southern Ontario (Peel Region, Region of Waterloo, Toronto District), and Nova Scotia completed the Food Behavior Questionnaire during the 2005-2006 academic school year. Ordinal logistic regression analyses were used to determine the associations between family dinner frequency and food behaviors and attitudes.

RESULTS

Higher family dinner frequency was significantly associated with less soft drink consumption, consuming breakfast on the day of the survey, the absence of a high body weight concern, having higher self-efficacy for healthy eating when at home with family, and during social times with friends.

CONCLUSIONS

Researchers and clinicians should be aware of these associations when planning family based healthy eating strategies.

A controlled evaluation of web-based training for teachers and public health practitioners on the prevention of eating disorders

The effectiveness of a web-based prevention program designed for elementary school teachers was examined in 78 elementary school teachers and 89 local public health practitioners (who provide support to schools). Participants were assigned to either the intervention (n = 95) or comparison (n = 72) study groups. All participants completed self-report online measures prior to, and following, the 60-day study period assessing knowledge about various factors that influence body image in children and efficacy to fight weight bias in the school. Information was also solicited on the feasibility of, and on the perceived benefit of the web-based program as a knowledge translation tool, in terms of layout and content. The Student Body program was found to be successful in improving knowledge concerning facts about dieting among the teacher participants, and in increasing efficacy to fight weight bias among the public health participants. Overall, the feedback was very positive concerning the layout and content of the Student Body. Participants reported an overall improvement in their awareness about how weight bias can be present in their teaching practices, and how this can trigger body image concerns among their students. Findings have implications for using the web to engage teachers in the prevention of disordered eating among school age children.

Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping

The objective was to describe weight concerns, dieting, and meal skipping of adolescents and to determine associations with the Healthy Eating Index-C (HEI-C). Data, that were collected using the Food Behaviour Questionnaire, revealed that participants (male=810, female=1016) in grades 9/10 reported weight concerns (n=518), dieting (n=364), and skipping breakfast (n=498), lunch (n=252), and/or dinner (n=129). Of those dieting or weight concerned (n=602), 61% were healthy weight and of those not dieting or weight concerned (n=1224), 13% were overweight/obese. The ordinal logistic regression analysis revealed that HEI-C was likely to be rated lower among those weight concerned and dieting (p<.001), and among those that skipped the breakfast meal (p<.001). The current study identified inappropriate weight concerns and dieting that compromised diet quality and has implications for future intervention and policy development.

Interactions between disturbed eating and weight in children and their mothers

OBJECTIVE

This study assessed the interaction between disturbed eating behavior and body mass index (BMI) in children aged 8 to 12 and maternal eating problems and BMI.

METHOD

In a cohort study, four hundred twenty-six 8- to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small city. Disturbed eating behavior in children was measured by the "IEG-IEG-Child-Questionnaire," a validated German self-report instrument for children. Disturbed eating behavior in mothers was assessed by TFEQ-subscale disinhibition.

RESULTS

Children's BMI was a significant covariate of disturbed eating. Older girls with higher BMI endorsed more problems with eating and weight, and more body dissatisfaction than boys and younger children. Daughters of overweight mothers restrained their own eating behavior more than daughters of normal weight mothers and sons regardless of mothers' weight. Older daughters of overweight mothers were more dissatisfied with their own bodies than younger daughters and children of normal weight mothers. Children of mothers with elevated disinhibition showed more body dissatisfaction than children of mothers with lower disinhibition.

CONCLUSIONS

The results illustrate the complex and differential relationships between age, gender, BMI, and maternal variables and eating disturbances in children. Preventive interventions for the reduction of disturbed eating in children should be targeted at overweight mothers and mothers with disinhibited eating.

Weight concerns among elementary school children: a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8-12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Structure analysis of the Children's Eating Attitudes Test in overweight and at-risk for overweight children and adolescents

BACKGROUND

In school-based samples of children, the Children's Eating Attitudes Test (ChEAT) has a four-factor structure; however, previous studies have not examined its factor structure in samples restricted to overweight youth.

METHODS

The ChEAT was administered to 220 overweight (BMI>or=95th percentile) and 45 at-risk for overweight (BMI 85th-<95th percentile) children and adolescents. Factors were identified by a principal component analysis with varimax rotation. ChEAT factor scores of children with BMI>or=85th percentile were contrasted with those of 152 non-overweight (BMI 5th to <85th percentile) children and adolescents.

RESULTS

Factor analysis generated four subscales described as 'body/weight concern,' 'food preoccupation,' 'dieting,' and 'eating concern.' ChEAT total score, body/weight concern, and dieting subscale scores were positively related to BMI-Z and body fat mass (p's<.05). Compared to non-overweight children, overweight and at-risk for overweight children had higher ChEAT total (9.9+/-7.4 vs. 6.6+/-7.8, p<.001), body/weight concern (3.2+/-3.1 vs. 1.3+/-3.0, p<.001), and dieting (1.8+/-2.2 vs. .8+/-2.3, p<.001) subscale scores.

CONCLUSIONS

The previously elucidated factor structure of the ChEAT was primarily supported in a sample of overweight children. The emergence of separate body/weight concern and dieting subscales may relate to these children's experiences with attempted weight reduction.

A Review of Family Meal Influence On Adolescents’ Dietary Intake

Recent concerns about adolescent nutrition and unhealthy weights have prompted an examination of the myriad influences on dietary intake during adolescence. Included here are a summary of the literature on family influence on dietary intake, specifically during adolescence and within the family context, a summary of family meal patterns, and a systematic review of the known influences of family meals on dietary intake. Because of the complexity of families in today’s society, models were developed to depict the broad context of familial influences on adolescent nutritional behaviours and attitudes and to describe what is known and not known about family meal influences on adolescent dietary intake and quality. A systematic review of the literature revealed seven articles specifically related to adolescents, family meals, and dietary intake, which were analyzed for strength of evidence and plausibility. In spite of data collection methods relying on self-report, results suggested that family meals were associated with improved dietary intakes. Families in today’s societies are complex. Nevertheless, parents have the potential to influence positively, through family meals, what food is provided, where it is provided (e.g., home, restaurant), and within what type of atmosphere it is provided.

Dieting in Spanish adolescent girls

This article examines the relation between dieting and non-dieting adolescent girls and body mass index (BMI), eating attitudes and the influence of the aesthetic body shape model. Three hundred forty-nine Spanish adolescent girls in their second year of secondary education were selected. The research design was a cross-sectional ex post facto study and validated measures were used to assess the main variables. Fourteen per cent of the sample was on a diet. Of this group, 69% were overweight, 70% had disordered eating attitudes and 70% were influenced by the current aesthetic body shape model. In all situations, the scores for dieters were significantly higher than those for non-dieters. Although there is not yet any clear consensus with regards to how adolescents interpret the term 'diet', the results indicate major differences between dieters and non-dieters and that those who self-report that they are on a diet present elements of the risk of developing eating and weight disorders.